Clinical and electrophysiologic findings in acute ischemic intraHisian bundle-branch block.
Clinical and electrophysiologic features of acute ischemic right bundle-branch block (RBBB) that are reversible by His bundle pacing were analyzed in nine patients. All had large anterior myocardial infarctions (mean peak CK-MB = 185 +/- 71 IU/l), and six showed increased pulmonary capillary pressures. The RBBB occurred within 48 hours of infarction, and in six patients it was associated with left fascicular block. The HV intervals that were measured 1 to 4 days after infarction were normal in all patients. Progression to complete atrioventricular (AV) block occurred in three patients, and one patient required permanent cardiac pacing. Sustained ventricular tachycardia developed in two patients, and ventricular fibrillation developed in five. During a mean follow-up period of 26 months, four patients died (three of them suddenly). The RBBB disappeared in only one case. Acute ischemic intraHisian RBBB occurred in the setting of massive myocardial infarctions complicated by ventricular tachycardia or fibrillation and by a high mortality rate during the follow-up period. The RBBB rarely reverted spontaneously, and the His-Purkinje conduction time was frequently normal.
Cortadellas
J
J
Servicio de Cardiología, Hospital General, Ciudad Sanitaria Valle Hebrón, Barcelona, Spain.
Cinca
J
J
Moya
A
A
Rius
J
J
D002036:Bundle of His; D002037:Bundle-Branch Block / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology*; D003645:Death, Sudden / Q000209:etiology; D004594:Electrophysiology; D006329:Heart Conduction System; D006439:Hemodynamics; D006801:Humans; D013617:Tachycardia, Supraventricular / Q000150:complications; D014693:Ventricular Fibrillation / Q000150:complications